Early complications of endoscopic treatment for superficial bladder tumors

Purpose: Bladder tumors are the second most common tumors of the genitourin ary system. Approximately 80% of patients initially present with a superfic ial lesion, which is treated with transurethral resection. Although transur ethral resection is a standard procedure, it is not morbidity-free. We asse ssed the early complications of transurethral resection for superficial bla dder cancer and analyzed various factors that may contribute to its occurre nce. Materials and Methods: Between January 1979 and December 1996, 2,821 patien ts with superficial bladder cancer underwent transurethral resection at our center. We assessed intraoperative and immediate postoperative complicatio ns of the initial transurethral resection procedure, and correlated them wi th tumor characteristics. Results: Of the 2,821 patients in our study 2,461 (87%) were male and 360 ( 13%) were female. Average age was 65 years (range 16 to 94). Of the 145 com plications (5.1%) the most common were bleeding in 78 patients (2.8%) and b ladder perforation in 36 (1.3%). Perforation was extraperitoneal in 30 case s (83%) and intraperitoneal in 6 (17%). Conservative treatment and open sur gery were done in 32 (89%) and 4 (11%) patients, respectively. We noted no case of tumor seeding. A repeat procedure was done in 77 patients (2.7%) wi th bleeding as the leading cause of repeat intervention in 65 (84%). Blood transfusion was required in 96 cases (3.4%). The incidence of complications significantly correlated with the size and number of tumors but there was no association with tumor stage, grade or location. Conclusions: The most common complication of transurethral resection for su perficial bladder cancer is bleeding. Currently bladder perforation should be managed conservatively with a minimum risk of extravesical tumor seeding . Our results imply that tumor size and multiple tumor resection are associ ated with a higher complication rate.